Healthcare Provider Details

I. General information

NPI: 1568375889
Provider Name (Legal Business Name): JIEUN JEONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HEARTHSTONE DR
KINNELON NJ
07405-2303
US

IV. Provider business mailing address

7 HEARTHSTONE DR
KINNELON NJ
07405-2303
US

V. Phone/Fax

Practice location:
  • Phone: 973-704-2266
  • Fax:
Mailing address:
  • Phone: 973-704-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15671600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: